Pathokinesiology Lab, Rancho Los Amigos National Rehabilitation Center, Downey, California, USA.
J Spinal Cord Med. 2020 Sep;43(5):594-606. doi: 10.1080/10790268.2019.1570436. Epub 2019 Feb 15.
Shoulder pain after spinal cord injury (SCI) is attributed to increased mobility demands on the arms and negatively impacts independence and quality of life. Repetitive superior and posterior shoulder joint forces produced during traditional wheelchair (WC) locomotion can result in subacromial impingement if unopposed, as with muscular fatigue or weakness. ROWHEELS (RW), geared rear wheels that produce forward WC movement with backward rim pulling, could alter these forces. Cross sectional. Research laboratory at a rehabilitation hospital. Ten manual WC users with paraplegia. Propulsion characteristics and right upper extremity/trunk kinematics and shoulder muscle activity were collected during ergometer propulsion: (1) self-selected free speed reverse propulsion with RW, (2) matched-speed reverse (rSW), and (3) forward propulsion (fSW) with instrumented Smartwheels (SW). Inverse dynamics using right-side SW rim kinetics and kinematics compared shoulder kinetics during rSW and fSW. Free propulsion velocity, cycle distance and cadence were similar during RW, rSW and fSW. Overall shoulder motion was similar except that peak shoulder extension was significantly reduced in both RW and rSW versus fSW. Anteriorly and inferiorly directed SW rim forces were decreased during rSW versus fSW propulsion, but posteriorly and superiorly directed rim forces were significantly greater. Superior and posterior shoulder joint forces and flexor, adductor, and external rotation moments were significantly less during rSW, without a significant difference in net shoulder forces and moments. Traditional propulsive-phase muscle activity was significantly reduced and recovery-phase muscle activity was increased during reverse propulsion. These results suggest that reverse propulsion may redirect shoulder demands and prevent subacromial impingement, thereby preventing injury and preserving independent mobility for individuals with paraplegia.
脊髓损伤（SCI）后肩部疼痛归因于手臂活动需求增加，并对独立性和生活质量产生负面影响。在传统轮椅（WC）运动中，反复的上肢和后肩关节力如果没有得到对抗，例如肌肉疲劳或无力，可能会导致肩峰下撞击。ROWHEELS（RW），即通过向后拉动轮辋来产生向前 WC 运动的齿轮后车轮，可以改变这些力。横断面。康复医院的研究实验室。10 名截瘫的手动 WC 用户。在测功机推进过程中收集了推进特性以及右上肢/躯干运动学和肩部肌肉活动：（1）使用 RW 进行自我选择的自由速度反向推进，（2）匹配速度反向（rSW），以及（3）使用仪器化 Smartwheels（SW）进行正向推进（fSW）。使用右侧 SW 轮辋动力学和运动学进行逆动力学，比较 rSW 和 fSW 期间的肩部动力学。在 RW、rSW 和 fSW 期间，自由推进速度、循环距离和步频相似。整体肩部运动相似，但 RW 和 rSW 中肩部伸展的峰值明显低于 fSW。与 fSW 推进相比，rSW 中向前和向下指向的 SW 轮辋力减小，但向后和向上指向的轮辋力明显增大。在 rSW 中，肩前和肩后关节力以及屈肌、内收肌和外旋力矩明显减小，而净肩力和力矩没有显著差异。传统推进阶段的肌肉活动显著减少，恢复阶段的肌肉活动增加。这些结果表明，反向推进可能会改变肩部需求，防止肩峰下撞击，从而预防损伤并保持截瘫患者的独立移动能力。
